Provider Demographics
NPI:1316942683
Name:LO, GARRICK J (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRICK
Middle Name:J
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 226TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7124
Mailing Address - Country:US
Mailing Address - Phone:425-961-0758
Mailing Address - Fax:
Practice Address - Street 1:8435 161ST AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1512
Practice Address - Country:US
Practice Address - Phone:425-885-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE94131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice